What to do if another healthcare provider's (HCP) mistake is intentionally hidden?

What to Do When Another Healthcare Provider's Mistake is Intentionally Hidden

If you discover that another healthcare provider is intentionally hiding a medical error, you have an ethical and professional obligation to ensure the error is disclosed to the patient and reported through appropriate institutional channels—failure to do so perpetuates harm and violates fundamental patient safety principles. 1, 2

Immediate Actions Required

1. Ensure Patient Safety First

• Assess whether the hidden error is causing ongoing harm to the patient and take immediate steps to mitigate any continuing risk 2
• Document the error, the harm (if any), and the circumstances of concealment in the medical record 1
• Implement monitoring or treatment as needed to address consequences of the error 1

2. Advocate for Disclosure to the Patient

• Patients have a fundamental right to know when medical errors occur—studies show 98% of patients desire acknowledgment of even minor errors 3
• The error must be disclosed with: a timely explanation of facts, acknowledgment of harm, expression of regret and apology, immediate management plan, and prevention measures 1
• Failure to disclose significantly increases litigation risk: 20% of patients would sue if they discovered a moderate error through other means versus only 12% if the physician disclosed it 3
• Patients want an honest explanation, a sincere apology, and information about prevention of recurrence 2, 1

3. Report Through Institutional Channels

• File a report with your institution's patient safety or quality improvement system immediately 2
• Report to both local and national incident reporting systems as required by institutional policy 1
• Healthcare organizations are required to have established policies for identifying and responding to medical errors 1

Navigating the Institutional Response

Work Within Your Organization's Structure

• Approach hospital leadership, risk management, or your patient safety officer if the provider refuses to disclose 2
• Most institutions now support disclosure and have policies requiring it—risk managers and hospital attorneys typically support appropriate disclosure efforts 2
• Frame the issue as a patient safety concern requiring systems-level intervention, not solely individual blame 2, 4

If Institutional Channels Fail

• Consider reporting to external oversight bodies if internal mechanisms are inadequate—42.8% of patient harms result in complaints to oversight agencies when disclosure is inadequate 5
• Document your attempts to address the issue through proper channels 2
• Consult with your own legal counsel or professional organization if you face retaliation for advocating for disclosure 2

Critical Pitfalls to Avoid

Do Not Participate in the Cover-Up

• Remaining silent makes you complicit in the concealment and violates your professional duty to the patient 2, 1
• Poor communication and lack of transparency are primary drivers of malpractice lawsuits—honest disclosure may actually reduce legal risk 1
• The traditional "blame and shame" culture that encourages hiding errors is being replaced by a culture of transparency and learning 6

Do Not Bypass Disclosure Entirely

• Going directly to external authorities without first attempting institutional disclosure may harm the patient-provider relationship and deny the patient timely information 1
• Patients deserve to hear about errors from their care team in a supportive manner, not discover them through investigation 2, 1

Recognize This is a Systems Problem

• Medical errors result from poorly designed systems, not just individual failures 4
• While the individual provider's concealment is unethical, focus on fixing the system that allowed both the error and the cover-up to occur 2, 4
• Blaming individuals rather than fixing systems perpetuates the problem and undermines the culture of safety 4

Supporting the Involved Provider

Address the "Second Victim" Phenomenon

• The provider hiding the error may be experiencing trauma from the event—classic manifestations include reliving the scenario, feeling solely responsible, and avoiding the patient 6
• Offer support while still insisting on disclosure: formal debriefing sessions focused on systems issues rather than individual blame can help providers process experiences 6
• Healthcare organizations should provide structured support programs and treat adverse events as opportunities for improvement rather than occasions for blame 6

Long-Term Institutional Changes to Advocate For

• Push for educational interventions on disclosure, transparency, and coping with medical errors integrated into all levels of training 2, 6
• Advocate for blame-free reporting mechanisms and transparent disclosure processes 6
• Support implementation of continuous quality improvement systems that learn from errors rather than punish individuals 2, 1
• Promote legal and contractual requirements for disclosure with apology protection for providers who disclose appropriately 7